Patient-Centered Care... Not

There is a big move in both the UK and the USA to adopt patient-centered care. Most people have no idea what that means. I received this article, among others on a health care networking site.

In the past five years or so, I've worked for organizations that try to care-manage patients to preempt health crises. So many of the people I have treated here answer the "Why didn't you call us earlier?" question with "I didn't want to bother anybody!" I never understood that. I spend my days explaining that we're doing our job, it is better for patients to call us at the first sign of a problem rather than wait until things are serious and wind up going to the emergency room or getting admitted to hospital. For two years, they have all looked incredulous when I've said this. Now I know why.

A few nights ago, we had a neighbor around for a pint. He's a nice chap and a doctor in the NHS. We started talking about health care, as one does, and he reveled in stories about telling patients how inappropriate they were to bother him with minor problems. He was very old school (although no older than myself), believing that "Doctor knows best" and that patients should not bother him with questions or concern themselves with things they could never understand. I don't mind sharing a pint with this chap, but I don't think I want him as my GP.

With a culture like that ingrained in the country, the NHS is going to have a heck of a time implementing patient-centered care! This only further strengthens my theory that the Prime Minister, in handing commissioning powers over to the general practitioners, has set the system up for failure.

4 comments

I once worked as a clinical manager in a work rehab facility. The surgeon was smart enough to know that there was a disconnect between physician and patient. It is a type of natural phenomenon. As medically educated as I am, I still freeze up when I am the patient. Can't explain it, but it happens. I react differently as a patient than as a practitioner.

The orthopedic surgeon had me sit in on every appointment, once the patient was enrolled in the program. During the doctor visit, I didn't say anything, just took notes. Later that day, or within a few days, I would get one on one with each patient and go over the doctor visit. Sometimes I would explain it differently, but often just hearing it from someone who was not a doctor was all it took for them to understand.

I don't know how practical it is to have this in every setting, but utilizing a liaison can be very effective in bridging communication gaps. In a patient centered model, as you have defined it, it seems this liaison is not optional.

Jane Goude

November 30, 2011 3:49 PM

Toni, I understand what you are saying and have been in the same situation...as a family member of a patient. I had a family member who had to make some decisions about treatment. They didn't take in fully what was being said, despite a very patient doctor, because the emotional response of potentially bad news prevented them from hearing and absorbing what was being said. From that point on, there was always someone accompanying them to appointments so that a full picture could be reviewed and discussed at home. Being that it was outpatient treatment helped, but we requested someone be present whenever things were explained when that person was an inpatient as well. The hospital agreed and was very accommodating.

Some people just don't process information as quickly as we, or health care organizations, would like them to. I appreciate your frustration with "less efficient healthcare provision" as I have felt it myself as a clinician. However, as we ask the public to absorb more and more of the financial burden of care, I think they have a right to a certain level of reasonable accommodation as well. Thanks for the flip side of this coin.

Dean Metz

November 17, 2011 12:06 PM

When I was working on my DPT a lot of time was devoted to patient oriented medicine. in theory this means the patient is the decision maker and should be included in all discussions, etc. The reality is somewhat different.

I observed many doctor/patient discussion on my unit. The problem isn't that the patient is excluded. The problem is the patient/family don't understand what they're being told. The docs go to great lengths to explain. They ask if everything was understood. Then when they ask for a decision they're met with blank stares.

I don't know if they aren't smart enough to understand or don't want to understand. I can personally vouch for numerous examples of selective hearing when I've tried. The end result is less efficient healthcare provision with no change in outcomes or patient/family satisfaction.

Toni Patt

November 16, 2011 7:07 PM

I was talking with Doc F(emale) about her previous colleagues. She had left the practice primarily because of one of them. I was sure I knew which one. Doc M(ale) was arrogant and dismissive. Even though I had three kids (and had killed none of them!) and a background in medicine, he made me feel like an imbecile. Doc F laughed. She said her mom felt the same way. Her mom was watching her kids and one got ill, so the grandmom brought the grandchild in. Doc M was the one she saw, b/c he was Doc F's favorite. Doc F's mom told her she would never be in a room with Doc M again.

Doc F said that Doc M was the best doctor at that practice (I think there were 5 total). But she said most all the moms couldn't stand him. She explained that he was like a papa bear protecting his cubs - the children - even if that meant protecting them from their human parents. She gave examples of the lengths he went to that showed his concern and compassion, including calling to check on a patient while he was in Paris.

Both of those practices are "old school": assuming the parent/patient is an idiot and making "house calls" from Paris. From his perspective both of his actions are providing patient-centered care.

Interesting article you linked. My favorite phrase is "service culture". For it to be authentic, it has to be the culture, and that is most certainly determined from the top. We have one hospital here in town the exemplifies that. I have a friend who had a mom that needed extended treatment at the hospital. She commented to her husband that if she ever went back to work, that is where she would go. The time came when she needed to. She applied and got hired. She's been there 5 happy years. She beams when she talks about working there. That is service culture. Administration serves the employees and the employees serve the clients. Win-win.

Janey Goude

November 16, 2011 1:19 AM

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